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Cirrhosis Management Prevention in Futures

Progress in the hepatic cirrhosis prevention and management of cirrhosis continues. Research is underway to determine the mechanism of scar formation in the liver and how the healing process can be halted or even reversed. The newest and best treatments for viral diseases of the liver are being developed to prevent progression to cirrhosis. Prevention of viral hepatitis by vaccination, which is available for hepatitis B, is in development for hepatitis C. The treatment of complications of cirrhosis are continuously developed and tested. Finally, the research aims to identify new proteins in the blood can detect liver cancer early or predict which patients will develop liver cancer.

Hepatic Cirrhosis Disease Brief Information

• Cirrhosis disease is a liver complication disease leading to loss of liver cells and irreversible scarring of the liver.
• Alcohol and viral hepatitis C and hepatitis C are common causes of cirrhosis, although there are many other causes.
• Cirrhosis can cause bruising, weakness, loss of appetite, yellowing of the skin (jaundice), fatigue and itching.
• The cirrhosis diagnosis can be suggested by history, blood tests and physical examination, and can be confirmed by liver biopsy.
• The complications of liver cirrhosis are edema and ascites, variceal bleeding, spontaneous bacterial peritonitis, hepatic encephalopathy, hypersplenism, hepatorenal syndrome, Hepatopulmonary syndrome and liver cancer.
• Treatment of cirrhosis is designed to prevent more damage to the liver, treatment of complications of cirrhosis, and prevention or early detection of liver cancer.
• Liver transplantation is becoming an important option for treating patients with advanced cirrhosis.

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Prevention Liver Cancer Detection and Transplantation

In this session, I will explain in detail about liver cancer prevention and early detection of liver cancer, and cirrhosis liver transplantation .

Prevention liver cancer and early detection of liver cancer

There are several types of disease that causes liver cirrhosis associated with a particularly high incidence of liver cancer, for example, hepatitis B and C, and would be useful to detect liver cancer and early surgical treatment or Liver transplantation can cure the cancer patient. The difficulty is that the methods available for research are only partially effective in identifying, at best, only 50% of patients in a curable stage of cancer. Despite the partial effectiveness of screening, most patients with cirrhosis, hepatitis B and C, are reviewed annually or every six months with liver ultrasound and measurement of proteins produced by cancer in the blood, for example , alpha-fetoprotein.

Cirrhosis Liver Transplantation

Cirrhosis is irreversible. Liver function in many patients become progressively worse despite treatment and complications of cirrhosis will increase and become difficult to treat. Therefore, when advanced cirrhosis, liver transplantation is often the only option for treatment. Recent advances in transplant surgery and drugs to prevent infection and rejection of the transplanted liver had significantly improved survival after transplantation. On average, over 80% of patients who receive transplants are alive after five years. Not all people with cirrhosis is a candidate for transplantation. Furthermore, there is a shortage of livers for transplantation, and usually have a (long months or years) to wait before a liver transplant to make it available. Therefore, measures to slow the progression of liver disease and to treat and prevent complications of cirrhosis are of vital importance.

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Complications of Cirrhosis Treatment Part 1

The treatment complications of cirrhosis include Edema and Ascites, Bleeding from Varices, Hepatic encephalopathy, Hypersplenism, Spontaneous bacterial peritonitis (SBP). In Complications of Cirrhosis Treatment Part 1, I will give more detail information about edema and ascites, also bleeding from varices.

Edema and Ascites

The salt and water retention can lead to swollen ankles and legs (edema) or abdomen (ascites) in patients with cirrhosis. Doctors often advise patients with cirrhosis of limiting the intake of salt (sodium) and fluid to reduce edema and ascites. The amount of salt in the diet is generally limited to 2 grams per day and the liquid to 1.2 liters per day. In most patients with cirrhosis, however, salt and fluid restriction is not enough, and diuretics should be added.

Diuretics are drugs that act on the kidneys to promote excretion of salt and water in urine. A combination of the diuretic spironolactone (Aldactone) and furosemide can reduce or eliminate the edema and ascites in most patients. During treatment with diuretics, it is important to monitor kidney function by measuring blood levels of blood urea nitrogen (BUN) and creatinine to determine if a diuretic is used too. Too many diuretics can cause kidney dysfunction leading to elevated urea and creatinine in blood.

Sometimes when diuretics are not working (in this case, is known as refractory ascites), a long needle or catheter is used to make the ascitic fluid directly into the abdomen, a procedure called abdominal paracentesis. It is common to remove large quantities (liters) of fluid in the abdomen when ascites is abdominal distention causing pain and / or difficulty breathing, as it restricts the movement of the diaphragm.

Another treatment of refractory ascites is a procedure known as porto-systemic shunt transjugular intravenous TIPS.

Bleeding from Varices

If large varices develop in the stomach, esophagus or superior in patients with cirrhosis are at risk of serious bleeding due to rupture of these varices. Once varices have bled, they tend to bleed and the likelihood that patients die each episode of bleeding is high (30% -35%). Therefore, treatment is needed to prevent the episode (original) first bleeding and rebleeding. Treatments include medications and procedures to reduce the pressure in the portal vein and procedures to destroy varicose veins.

* Propranolol (Inderal), a beta blocker, is effective in reducing the pressure in the portal vein and is used to prevent the initial hemorrhage and rebleeding of varices in patients with cirrhosis. Another class of oral drugs that lower portal pressure is nitrates, eg isosorbide dinitrate (Isordil). Nitrates are often added to propranolol, while propranolol alone is not enough to reduce portal pressure and prevent bleeding.

* Octreotide (Sandostatin) also reduces the pressure of the portal vein and is used to treat variceal bleeding.

* During upper endoscopy (EGD) or sclerotherapy or ligation can be performed to remove varicose veins and stop the bleeding and prevent rebleeding. Sclerotherapy involves injecting small doses of sclerosing solution into varicose veins. Sclerosing solutions cause inflammation and scarring and varicose veins, erasing in the process. Band ligation is the use of rubber bands around the varices to erase. (Ligation of varicose veins is similar to rubber bands of hemorrhoids.) Complications of sclerotherapy: esophageal ulcers, bleeding ulcers of the esophagus perforation, esophagus, esophageal stricture (narrowing due to scarring that can cause) , dysphagia, mediastinitis (inflammation of the lungs that can cause chest pain), pericarditis (inflammation around the heart can cause chest pain), and peritonitis (infection of the abdominal cavity). Studies have shown that ligation may be slightly more effective with fewer complications than sclerotherapy.

* Transjugular intrahepatic portosystemic shunt (TIPS) is a surgical procedure to relieve pressure in the portal vein. TIPS is performed by a radiologist inserts a catheter (tube) into a vein in the neck to the inferior vena cava and hepatic vein in the liver. The stent then so that one end is in the high pressure portal vein and the other is in the low-pressure hepatic vein. This blood will not pass through the tube around the liver and therefore decreases the pressure in the portal vein and varicose veins and prevents bleeding varices. TIPS is particularly useful in patients unresponsive to beta-blockers, sclerotherapy of varicose veins or bands. (TIPS is also useful in the treatment of patients with ascites do not respond to salt and fluid restriction and diuretics.) TIPS can be used in patients with cirrhosis to prevent variceal bleeding while patients are awaiting transplant hepático. The most common side effect of TIPS is hepatic encephalopathy. Another major problem is the development advice of narrowing and occlusion of the stent, causing the recurrence of portal hypertension and variceal bleeding and ascites. The ranges of estimated frequency of stent occlusion in 30% -50% in 12 months. Fortunately, there are ways to open occluded stents. Other complications include bleeding boards due to accidental perforation of the capsule of the liver or bile duct, infection, heart failure and liver failure.

* A surgical operation to create a bypass (step) of the vein portal vein high pressure to low pressure can reduce blood flow and portal vein pressure and prevent variceal bleeding. The surgery is called distal splenorenal shunt (DSRS). To consider a bypass surgery in patients with portal hypertension who have early cirrhosis. (The risks of bypass surgery for these patients is lower in patients with advanced cirrhosis.) During DSRS, the surgeon separates the splenic vein, portal vein and attached to the renal vein. Blood is diverted from the spleen to the liver, lowering blood pressure in the portal vein and varices and prevention of variceal bleeding.

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Diabetes Cirrhosis Treatment to Prevent Liver Damage

The treatment of diabetes cirrhosis treatment include : prevent further damage to the liver, treatment of complications of cirrhosis, early detection and prevention of liver cancer, and liver transplantation.

And I will explain more detail the diabetes cirrhosis treatment steps, starting from how to prevent further damage to the liver.

• Eat a balanced diet and a daily multivitamin. PBC patients with impaired absorption of fat soluble vitamins may need supplements of vitamins D and K.
• Avoid drugs (including alcohol) that causes liver damage. All patients with cirrhosis should avoid alcohol. Most patients with cirrhosis induced by alcohol experience an improvement in liver function with abstinence from alcohol. Even patients with hepatitis B and C can significantly reduce liver damage and slow the progression to cirrhosis with alcohol withdrawal.
• Avoid anti-inflammatory drugs (NSAIDs, eg ibuprofen). Patients with cirrhosis may experience a worsening of liver and kidney with NSAIDs.
• Reducing hepatitis B and hepatitis C using anti-viral drugs. All patients with cirrhosis from chronic viral hepatitis are candidates for drug therapy. Some patients may experience a severe deterioration of liver function and / or intolerable side effects during treatment. Therefore, decisions to treat viral hepatitis should be individualized after consultation with physicians experienced in treating liver diseases (hepatologists).
• Removal of blood from patients with hemochromatosis to reduce iron levels and prevent further damage to the liver. In Wilson’s disease, medications can be used to increase copper excretion in the urine to reduce levels of copper in the body and prevent further damage to the liver.
• Remove the immune system with drugs such as prednisone and azathioprine (Imuran) to reduce inflammation of the liver in autoimmune hepatitis.
• Treat patients with primary biliary cirrhosis with a preparation of bile acid, ursodeoxycholic acid (UDCA), also called ursodiol (Actigall). The results of an analysis that combines results from several clinical trials have shown that UDCA improved survival in patients with PBC during 4 years of treatment. The development of portal hypertension has also been reduced by UDCA. Importantly, despite evident benefits, UDCA treatment delays progression and above all, not a cure for PBC. Other drugs such as colchicine and methotrexate may also have benefits for subgroups of patients with PBC.
• Patients with cirrhosis of immunizing against infection with hepatitis A and B to prevent a serious deterioration of liver function. There is currently no vaccine available for immunization against hepatitis C.

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